Cancer patients must know options

June 10, 2012|By Amanda Vahabi

Letitia, a 39-year-old single mom, was diagnosed with breast cancer in 2006. Although Letitia consulted with two different doctors in the course of planning her treatment, neither mentioned breast reconstruction. A full mastectomy was performed and both breasts were removed.

It was only years later that Letitia learned that insurance covered reconstruction. When asked why she didn't undergo reconstruction at the time of her mastectomy, Letitia replied, "no one had mentioned it was an option."

Many women like Letitia do not have breast reconstruction surgery after a mastectomy because either they are unaware that most insurance, including Medicaid and Medicare, covers it, or because the option is never mentioned to them by their doctors. According to a 2009 poll published by the American Society of Plastic Surgeons, 70 percent of women with breast cancer who are eligible for breast reconstructive surgery after a mastectomy are not informed by their doctors that the option exists.

To solve this problem, New York and Texas recently implemented laws requiring hospitals and doctors to both discuss breast reconstruction options with their patients before cancer surgery and provide the patient with information about insurance coverage. Unlike New York and Texas, Florida has no such law in place, but it should. Florida should follow the lead of New York and Texas lawmakers and require doctors to discuss the option of breast reconstruction and insurance coverage after a mastectomy.

Dr. John C. Oeltjen, a plastic surgeon at the Miller School of Medicine, says the law "would create uniformity among hospitals as far as disclosure of patient options goes," but argues it "would not solve all the logistical problems of coordinating consultations and then surgeries ..."

More strongly opposed to the idea is Dr. Eli Avisar, a breast cancer surgeon at the Sylvester Comprehensive Cancer Center who argues "there is no need…for a law requiring physicians to discuss this with patients just as there is no need for a law requiring a physician to perform surgery for appendicitis. This all falls under the category of standard of care."

Diana Rowden, a breast cancer survivor and health care advocate, believes that this type of "legislation may not be the answer" to the underutilization of breast reconstruction and instead suggests that "a more appropriate approach is to ensure that practice guidelines include discussion of breast reconstruction as an option."

But Kathy-Ellen Kups, a breast cancer survivor and author of a breast cancer blog, disagrees. She supports all efforts ensuring women have access to the services and procedures they need. "Women are missing out on much needed information. In my case, my mother-in-law brought me an article discussing the law that specifies that insurance companies are obligated to cover reconstructive procedures," says Kathy.

Breast reconstruction after a mastectomy is a significant medical option. Every cancer patient should be told it is available if her insurance covers it. The fact that reconstructive surgery after a mastectomy is covered under most insurance policies is not helpful to the cancer patient if their doctor never makes them aware of it.

Laws of this kind might present obstacles at first in terms of regulating compliance, as most laws do, but for the one out of eight women who will develop cancer at some point in life, this law may make an enormous difference.

Amanda Vahabi is a third year student at the University of Miami School of Law.